Rotator Cuff After Surgery

The rotator cuff is a group of four muscles and tendons that is important in maintaining shoulder stability and movement. There are many types and causes of rotator cuff injuries such as a fall or a condition that becomes progressively worse over time. These actions can lead to major injuries to the rotator cuff; ranging from inflammation resulting in tendonitis to a tear that could require surgery to rectify it.

There are three different types of surgery that can be performed depending on the type of injury. They are impingement surgery, rotator cuff repair, and arthroscopic surgery. All types of rotator cuff surgery usually takes one to two hours during which time the patient is placed in a half sitting position and given local anesthesia that blocks the nerves rendering the patient unable to feel the pain. Sometimes a sedative will be given to allow the patient to remain conscious but sleepy. Once the patient is prepped, the surgery will begin.

When the rotator cuff tendons become pinched between two bones, impingement surgery is performed to shave a portion of the bones so that the tendon has room to move thereby preventing them from being pinched. This type of surgery is also used to relieve chronic tendonitis and also as a part of normal rotator cuff surgeries. Arthroscopic surgery is a procedure in which traditional rotator cuff repair is done but it is completed with special instruments.

A button hole sized incision is made in the shoulder and the doctor inserts a pen shaped, thin tube containing a video camera and surgical instruments. The entire operation is done remotely while watching it on a video screen. Although this method carries fewer risks, a smaller incision scar, and faster recovery time it is not performed very often because rotator cuff surgery is complicated and typically requires an open incision.

Traditional rotator cuff repair surgery is when the damaged tendon is reattached to the upper arm. This is a rather complex operation and requires several important steps. The first step requires the surgeon to make a two or three inch cut in the shoulder then cutting into the deltoid muscle. The second step involves removing any and all scar tissue that has built up on the tendon. Third, small holes are drilled into the bone and finally, sutures are used to sew the damaged tendons to the bone. Upon completion of the surgery, the patient’s arm is placed in a sling to heal — which takes a long time due to the poor blood supply that this area receives.

Unfortunately, surgery alone is not enough to fully repair a damaged rotator cuff. The weeks and months after the surgery are some of the most important and difficult as a patient must engage in rehabilitative exercises and physical therapy. Most physical therapy begins before the patient even leaves the hospital. It is the role of the physical therapist to teach the patient special exercises to regain full usage and strengthen their shoulder.

Some of the exercise that should be done is the pendulum swing, assisted shoulder flexion, wall walking, external rotation, and standing rotations. Many of these exercises can be done from the comfort of home under the care of a therapist and are implemented in stages based on your range of motion and level of pain. For example, the pendulum swing is typically one of the first exercises used as it is rather easy while the wall walking isn’t usually used until about twelve weeks post-op because it requires a large range of motion.

In addition to the many exercises that can be done at home, some patients also need to undergo physical therapy. During physical therapy, the therapist will assist you in making passive motions with your shoulder. Once you are able to do this consistently, your therapist will then allow you to move your arm on your own. However, it is imperative to remember that physical therapy is about learning to move your arm again, not becoming stronger. And under no circumstances should it hurt. Granted, it will be painful but it should not cause a lot of discomfort.

Many patients feel as though engaging in physical therapy so quickly after surgery is unnecessary. However, the flexibility and strengthening that these exercises provide are very beneficial. They not only restore the use of your arm but they decrease the amount of healing time from months or years to only weeks. Additionally, a well designed exercise program can limit the amount of pain medication a patient will need.